ER medicine without the panic button

On this week's episode of The Vet Blast Podcast, dvm360 welcomes Anthony R. Coronado, DVM, to our show to discuss what is essential to a crash cart for emergency medicine cases. Through the episode, Coronado and our host Adam Christman, DVM, MBA, discuss what items to stock for your crash card, the importance of regular expiration date checks and training programs to ensure teams are ready for an emergency, plus some common mistakes veterinary professionals make when it comes to emergency cases and the pros and cons of what it is like to work in emergency medicine.

Anthony R Coronado, DVM

Below is a partial transcript, edited lightly for clarity.

Adam Christman, DVM, MBA: Okay, so let's talk about the crash cart. This is so, so crucial. The reason why we're having this conversation, Doc, is we've been approached by listeners and learners about this, and have certain Have things changed, certain things run back order, and we're here to have you kind of help us, guide us along the way. So let's kind of talk about some of the non negotiables, if you will. What are some of the non negotiables that are in a crash card set up or a restock process?

Anthony R. Coronado, DVM: I would say that every hospital is different in terms of what they prefer to have in their crash cart. And so the main thing is being consistent in what you have in there. More importantly, though, regardless what you keep in or on top of your crash cart, the most important thing is that it is stocked and it is secured so that people aren't using it for the day to day treatment of patients. Too many times I see that where somebody's using it for catheters, for grabbing a drug here, and then when a crisis hits, that cart isn't ready for what it's designed for. And so what you want to do is keep it stocked at all time. You've got a breakaway lock on there, and you want tape on there that says this was restocked at this time by this person, so that you know that it's ready to go, and so you're there when you need it. You know, in terms of items, drugs are going to change, you know, like you said, things are on back order. Some require in depth calculations that take a while. So they're not necessarily crash items. But you want to have, you know, chest tube placement kits you want to have pericardial Pericardiocentesis kits ready thoracosynthesis kits ready block cat unblocking kits ready for them.

Tracheal tubes of all sizes if you have them, and you can get them for tracheostomy tubes, but you can also cut your own trach tube down in an emergency situation, catheters of all sizes. In a shock situation, you want the bigger, the better. That is a common mistake. I see people just put in tiny catheters and a giant dog, and you're just not able to deliver the fluids they need along that lines. Then you might want to have central lines ready and IO catheters with a driver, so you can get fluids in those right away. And of course, you want the fluids that we just talked about handy, so your basic Crystalloids ready to go, and hypertonic saline, little controversial whether you want hetastarch or Vetstarch, because of the concerns behind there, but go with those first few, and then epinephrine atropine.

Now, whether you have access to pressers or not. Again, those are one of the ones that have a lot of calculations go with them. But some people prefer to have those in the carts. I like to have insulin ready for those crashing blocked cats. I prefer calcium gluconate because I'm comfortable with it. To have that ready for those guys too, because you can make a world of difference in a very short time.

Here is the Crash Cart Checklist.